Children's Health and Wellness

The Neonatal Intensive Care Unit (NICU)

The birth of a baby is a wonderful yet very complex process. Many physical and emotional changes occur for mother and baby.

A baby must make many physical adjustments to life outside the mother's body. Leaving the uterus means that a baby can no longer depend on the mother's circulation and placenta for important physiologic functions.

Baby in a Neonatal Intensive Care Unit

Before birth, breathing, eating, elimination of waste, and immunologic protection all came from the mother. When a baby enters the world, many body systems change dramatically from the way they functioned during fetal life:

  • The lungs must breathe air.

  • The cardiac and pulmonary circulation changes.

  • The digestive system must begin to process food and excrete waste.

  • The kidneys must begin working to balance fluids and chemicals in the body and excrete waste.

  • The liver and immunologic systems must begin functioning independently.

Your baby's body systems must work together in a new way. Sometimes, a baby has difficulty making the transition to the world. Being born prematurely, having a difficult delivery, or birth defects can make these changes more challenging. Fortunately for these babies, special newborn care is available.

What is the neonatal intensive care unit?

Newborn babies who need intensive medical attention are often admitted into a special area of the hospital called the Neonatal Intensive Care Unit (NICU). The NICU combines advanced technology and trained health care professionals to provide specialized care for the tiniest patients. NICUs may also have intermediate or continuing care areas for babies who are not as sick but do need specialized nursing care. Some hospitals do not have the personnel or a NICU and babies must be transferred to another hospital.

Some newborn babies will require care in a NICU, and giving birth to a sick or premature baby can be quite unexpected for any parent. Unfamiliar sights, sounds, and equipment in the NICU can be overwhelming. This information is provided to help you understand some of the problems of sick and premature babies. You will also find out about some of the procedures that may be needed for the care of your baby.

Which babies need special care?

Most babies admitted to the NICU are premature (born before 37 weeks of pregnancy), have low birth weight (less than 5.5 pounds), or have a medical condition that requires special care. In the U.S., nearly half a million babies are born preterm, and many of these babies also have low birth weights. Twins, triplets, and other multiples often are admitted to the NICU, as they tend to be born earlier and smaller than single birth babies. Babies with medical conditions such as heart problems, infections, or birth defects are also cared for in the NICU.

The following are some factors that can place a baby at high risk and increase the chances of being admitted to the NICU. However, each baby must be evaluated individually to determine the need for admission. High-risk factors include the following:

  • Maternal factors:

    • Age younger than 16 or older than 40 years

    • Drug or alcohol exposure

    • Diabetes

    • Hypertension (high blood pressure)

    • Bleeding

    • Sexually transmitted diseases

    • Multiple pregnancy (twins, triplets, or more)

    • Too little or too much amniotic fluid

    • Premature rupture of membranes (also called the amniotic sac or bag of waters)

  • Delivery factors:

    • Fetal distress/birth asphyxia (changes in organ systems due to lack of oxygen)

    • Breech delivery presentation (buttocks delivered first) or other abnormal presentation

    • Meconium (the baby's first stool passed during pregnancy into the amniotic fluid)

    • Nuchal cord (cord around the baby's neck)

    • Forceps or cesarean delivery

  • Baby factors:

    • Birth at gestational age less than 37 weeks or more than 42 weeks

    • Birth weight less than 2,500 grams (5 pounds, 8 ounces) or over 4,000 grams (8 pounds, 13 ounces)

    • Small for gestational age

    • Medication or resuscitation in the delivery room

    • Birth defects

    • Respiratory distress including rapid breathing, grunting, or apnea (stopping breathing)

    • Infection such as herpes, group B streptococcus, chlamydia

    • Seizures

    • Hypoglycemia (low blood sugar)

    • Need for extra oxygen or monitoring, intravenous (IV) therapy, or medications

    • Need for special treatment or procedures such as a blood transfusion

Who will care for your baby in the NICU?

The following are some of the specially trained health care professionals who will be involved in the care of your baby:

  • Neonatologist. A pediatrician with additional training in the care of sick and premature babies. The neonatologist (often referred to as the attending physician) supervises pediatric fellows and residents, nurse practitioners, and nurses who care for babies in the NICU.

  • Neonatal fellow. A pediatrician currently receiving additional training in the care of sick and premature babies. He or she may perform procedures and direct your child's care.

  • Pediatric resident. A physician currently receiving additional training in the care of children. He or she may perform or assist in procedures and help direct your child's care.

  • Neonatal nurse practitioner. A registered nurse with additional training in the care of newborn babies. He or she can perform procedures and help direct your child's care.

  • Respiratory therapist. A person with specialized training in providing respiratory support including managing breathing machines and oxygen.

  • Physical, occupational, and speech therapists. Physical and occupational therapists make sure a baby is developing appropriately and help with developmental care including positioning and soothing techniques. Speech therapists assist with helping babies learn to eat by mouth.

  • Dietitians. Dietitians ensure the babies are growing appropriately and receiving appropriate nutrition including calories, protein, vitamins, and minerals.

  • Lactation consultants. Lactation consultants are health care providers with additional training and certification in helping women breastfeed. They can help with pumping, maintaining milk supply, and initiating breastfeeding.

  • Pharmacists. Pharmacists help in the NICU by assisting the care providers in choosing the best medications, monitoring drug dosing/levels, and keeping the team aware of possible side effects and necessary monitoring.

  • Social workers. Social workers assist families with dealing with a wide range of emotions they face when a child is ill, help families obtain needed information from physicians, and support the family with other more basic care needs such as financial problems, transportation, or arranging home health care.

  • Hospital chaplains. The hospital chaplain might be a priest, minister, lay pastor, or other religious advisor who can provide spiritual support and counseling to help families cope with the stressors of the NICU experience.

The members of the NICU team work together with parents to develop a plan of care for high-risk newborns. Ask about the NICUs parent support groups and other programs designed to encourage parental involvement.

Online Source: Breastfeeding Your Baby, American College of Obstatriciand and Gynecologistshttp://www.acog.org/~/media/For%20Patients/faq029.pdf
Online Source: National Prematurity Awareness Month, CDChttp://www.cdc.gov/features/prematurebirth/
Online Source: Staff in the NICU, March of Dimeshttp://www.marchofdimes.org/baby/staff-in-the-nicu.aspx
Online Source: Pediatric Neonatology, Council of Pediatric Specialistshttp://www.pedsubs.org/subdes/Neonatology.cfm
Online Source: Patient information: What to expect in the NICU (The Basics), UpToDatehttp://www.uptodate.com
Online Editor: Metzger, Geri K.
Online Medical Reviewer: MMI board-certified, academically affiliated clinician
Online Medical Reviewer: Trevino, Healther, M., BSN, RNC
Date Last Reviewed: 11/26/2014
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